It is a digital, cloud-based solution that connects all stakeholders engaged in the provision, management and monitoring of vaccines and enables the following:

• beneficiaries (patients) to self-register, at no cost, using different channels including a feature phone and to nominate or be linked to a specific Vaccine Service Point (VSP)

• the Ministry of Health (and its nominated partners) to view aggregated demand per VSP which is used to inform subsequent stock replenishment if required

• the Ministry of Health (and its nominated partners) to schedule beneficiary vaccinations against:

  • Cohort prioritisation with regard to Government Policy, e.g., Health care workers

  • Availability of stock in country (batch arrivals; batch quantity)

  • Availability of stock per VSP

  • Aggregated demand per VSP

  • Vaccination throughput per VSP.

• beneficiaries -via redemption of an SMS based token - to receive vaccinations at a VSP and to receive treatment fulfilment digital certification.

• The Ministry, via APIs to connect/integrate with, inter alia:

  • Any MoH nominated data repository, e.g., DHIS2, Home/Internal Affairs Population Registries etc

  • Any MoH nominated 3rd Party cold chain solution

  • Any MoH nominated Pharmacovigilance function

The value proposition is (i) to enable data informed decision-making by Ministries of Health and nominated stakeholder groups so as to ensure that the desired COVID-19 vaccine deployment rate and population immunisation coverage is achieved (ii) the longer term strengthening/resilience of health care systems.

A successful mVacciNation deployment requires a number of key activities to be supported over and above the technology component provided by Mezzanine, these include:

• ICT hardware, messaging services & connectivity[1] and

• critical non-technical inputs like health & operational implementation programme management, training of enterprise users, user support and effective stakeholder management.

[1]  The Mezzanine digital solutions can be provided by any GSM mobile network operator in Africa.

No; the offering is GSM network agnostic and can be deployed across third party GSM networks. 

Yes, at a country level to enable Ministries of Health to procure technology (SaaS licenses), ICT and Implementation services.

The Public Sector is the focal point, as most AU Member States will be the locus of control for National vaccine provision. However, the Private Sector will invariably participate in the delivery and support of vaccines (e.g., as is the case in South Africa and what is proposed, inter alia, in Kenya). Mezzanine is comfortable to work with any stakeholder, under guidance of the Ministry.

It is focused on Africa and all its Member States.

The technology is already deployed in South Africa. It will take 4-8 weeks to deploy elsewhere in Africa. Note that the technology is only one service component; it is incumbent on Ministries of Health and their partners to have secured ICT and Implementation services prior to activation.

Success in deploying any technology can be measured by acceptance and adoption of the digital tool (in the field) and the incorporation of the data it generates at programme and policy levels to inform decisions. In short, success is about effective programmes and change management. This is a relatively ‘low tech’, but a high friction requirement over a minimum 2-year term (Mezzanine recommendation). Implementation requires credible, domain expert entities - in country - that can support both the field experience and the programme and policy experience. Some of the key performance areas include, inter alia:

• User training

• User support (throughout the value chain)

• Country specific policy and SOP updates

• Change management and adoption

• Monitoring & Evaluation

• End user adoption management

• Overall Programme Management

Mezzanine Digital Technologies operate off a shared service multi-tenancy framework that can be integrated with legacy and 3rd Party systems, including Information Management tools and repositories such as LIS, DHIS2, Cold Chain IoT systems etc. This is an expected requirement; Mezzanine are comfortable with this. As an example, the deployment of the EVMS in South Africa is integrated into 20 different systems. The commercial offering to countries includes a maximum of five (5) 3rd party API integrations.

The following formal agreements are in place (as of 10th March 2021):

• National Department of Health, South Africa [as EVMS]

• AUDA NEPAD: program support and potential co-funding

The following countries have received commercial proposals for Covid 19 Vaccine deployments:

• Uganda

• eSwatini

• Kenya

• Zimbabwe

• Zambia

• Tanzania

Mezzanine health services have previously been/are deployed in the following countries:

• Nigeria

• Zambia

• South Africa

• Mozambique

• Tanzania

• Kenya

There are multiple ways to effect registration, including

• Remote self-registration via USSD/SMS/WhatsApp/Web Application engagement of unknown eligible recipients:

  • With targeted messaging this method allows users to self-register without travelling to a physical registration station.

  • A subsequent eligibility check will need to be completed by an MoH nominated service provider to verify these self-registering individuals.

  • In later phases of implementation this will be particularly important, when many recipients will have limited access to digital services, and low levels of digital literacy.

• Existing databases of cell phone numbers of known eligible individuals (via API or download/upload) who will be engaged via bulk messaging to enter the workflow for allocating vaccination slots, e.g., Public Sector employee databases.

• Registration by field agents using the Mezzanine mVacciNation Android native application (e.g., door-to-door enrolment etc.)

• Linking into other channels of registration. The platform approach enables ease of integration with additional channels of enrolment (front end), should this be required, e.g., various web applications, call centres etc. These can also be accommodated in a phased approach once the requirements are understood.

The solution can support configurable eligibility rules set against the available data elements (mVacciNation country data model), particularly for later roll-out phases. The solution enables a centralised database management using adaptable, mixed criteria for eligibility. This process can be done in phases, if integrations require long lead-times. Initial qualification can be done using exports from these databases or similar.

Once rule sets are created, these can assist with in-time and ever evolving eligibility management.

This is an expected challenge. Our experience in the field suggests that potentially 20-30% of adult beneficiaries may lack a mobile phone (especially women). It is unknown how many of this cohort has access to a SIM. Irrespective, we consider the following potential solutions (non exhaustive):

• Supported registrations through either community health workers or through employers

• potential beneficiaries use/nominate a proxy (e.g., a family member, or community leader) device to register and receive notifications

• MNO’s/others subsidise the provision of SIM’s or Hardware to beneficiaries or proxy nominees.

Mezzanine does not provide any specific services to address vaccine hesitancy as part of mVacciNation. However, during the pandemic Vodacom has worked closely with governments to deliver public health messages via SMS, and in some cases set up call centres for Covid-19 information. Where there is a demand from governments, we can explore doing the same for the vaccine rollout. However Additionally, Mezzanine, via its MNO partners and potentially via other 3rd Parties, including Clickatell and Praekelt, could support the handling of any inbound queries and outbound compliance and demand generation messaging if required[2].

[2] The system does provide scheduled messaging with regard to upcoming vaccine events per person.

Mezzanine provides mVaccination on a SaaS (off the shelf) basis; the contract period is a minimum of 12 months.

Service inclusions

• Software as a service off-the-shelf

• Global hosting

• Maintenance and Enterprise Service Level guarantee

• Dedicated application instance

• 10 SMS per app user per month

• 1 BI user per 25 app users

• Unlimited web app users

• Third line support (technology)

• Adoption reports

Service exclusions

Excluded (can be quoted separately):

• Training of trainers

• Deployment & device management

• Second line support (technology)

• Hardware / Devices

• Connectivity

• In-country hosting

• Additional features

Excluded (Implementation Partner/Client)

• First line support

• End user training

• Policy and SOP updates

• Change management and adoption

Yes. This is part of the country localisation effort.

Mezzanine has significant experience in deploying digital services in Africa, particularly at the junction of the first mile~last mile in Public healthcare. The following evince this claim:

1. Deep Insights into Pharmaceutical & Laboratory Supply Chain Context

   • Healthcare is a complex adaptive environment and requires agile, collaborative responses. Mezzanine’s digital health solutions are developed and delivered in collaboration with subject matter experts, ensuring alignment with international and local best practices and guidelines.

   • Mezzanine has co-created and provided inter alia, the National Department of Health in South Africa, with the enterprise solution known as Stock Visibility, since 2015, as well as the Master Health Procurement Catalogue, and other ad hoc projects. The Mezzanine team includes industrial engineers and health economists specialising in supply chain and logistics management, as well as pharmaceutical procurement.

   • Mezzanine also provides eLABS, a pathology digitisation service to the Wits Health Consortium (WHC), which currently communicates Viral Load (HIV Program) and COVID PCR test results to over 1500 facilities across PEPFAR Priority Districts in South Africa and 800 Facilities in Zambia.

2. Market validated Beneficiary Registration, Management, Scheduling and Redemption toolbox

   • Mezzanine has an eVouchering capability that enables enterprises to enrol beneficiaries (through mixed channels), manage eligibility, and distribute value to beneficiaries in the form of vouchers (referred to hereafter as tickets) for goods or services. It also enables enterprises to match demand and supply, by matching tickets issued to supply chain planning processes. This solution has been deployed in multiple African Countries and is currently managing over a dozen active programs.

3. Proven ability to manage complex, large-scale deployments within rapid timelines

   • Mezzanine has over 25 live projects across health, agriculture, education and financial services sectors, and has worked in 10 countries across the continent since 2012. Our health products have over 89% sustained user adoption, illustrating the human centred design and health system strengthening approach adopted.

   • In 2015/16 Mezzanine supported NDOH with the rapid deployment of SVS, including hardware and connectivity, to over 2000 facilities within the space of a month and a half, including training and rapid customisation.

   • In 2017/18 over 2.5 million beneficiaries were registered and assessed for social grant eligibility in Zambia within a month and a half on behalf of the central government.

   • In 2020 Mezzanine supported both NDOH and WHC/NHLS with rapid responses to the COVID19 crisis, digitising over 2,000 new service points for either SVS or eLABS in less than two months.

4. Client-centric, and responsive approach to service delivery

   • Mezzanine has a long track record of supporting Countries and other health organisations with evolving requirements in an operationally complex environment. The team understands the operating and governance models, as well as the stakeholder landscape. A respectful approach to service delivery is always adopted, including discretion and confidentiality about sensitive information and stakeholder management. A dedicated support desk ensures a proactive, responsive approach to user engagement.

5. Formal Service Levels Guarantees & Data Governance

   • Mezzanine provides a 99.9% availability guarantee and commitments for turn-around-times that are on par with world class enterprise services. 24hr monitoring protocols are in place to ensure service delivery continuity. Mezzanine collects, processes and stores information on behalf of clients in alignment with ISO 270001 information security standards, as well as local regulations and policy requirements.

The key risks associated with the deployment of mVacciNation into any of the AU Member States are captured below.

All Mezzanine software solutions are provided as a Software as a Service (SaaS) contract. The mVacciNation SaaS Enterprise SLAs include SaaS and all underlining multi-tenant Platform as a Service (PaaS) and Infrastructure as a Service (IaaS) services. AU Member States benefit from the shared services environment in terms of quality of service (SLAs), affordability, scalability and improved interoperability across applications and information across information ecosystems (refer to the note below).
 

The mVacciNation SLA offering to AU member states will be as a cloud hosted solution. Authorised Country specific users, mobile and web, will be enrolled against the Country account.  Access rights can be configured.

The benefits of the multi-tenant cloud instance are:

• A state-of-the-art Internet Hosting Environment – a fully managed and secure service that includes server monitoring, back-up and failover services.

• Fully secure – 24/7/365 security, including biometric physical access control, firewalling and full environment monitoring.

• Skilled and competent support – A 24/7/365 Client Services Operations Centre, fully geared with highly skilled engineers.

• Stability and guaranteed uptime – comprehensive server-management and engineering support to ensure maximum availability. Redundant facilities for co-located hosting solutions.

• Managed Virtual Hosting - virtualization allows for rapid scaling of deployment should the user require the collection of additional Information/data/data.

• App engines - this allows applications to be built and run on the shared platform, accessing all shared services and benefits.

• User interfaces - A variety of coordinated user interfaces including web, native android interfaces and HTML5 mobile containers

• Development kits and standards - these kits include compilers, debugging and testing tools, widget libraries and more to assist internal (and external) developers with deploying applications to the platform environment.

• Core RESTful Web Services - Each of Helium's core business services publish RESTful web services for integration into Helium middleware and Helium app engines.  These web services can also be used by third party platforms to leverage Helium's integrations into mobile network operator services etc. This enables clients to integrate their legacy systems into a platform environment.

• App RESTful Web Services - Helium's app engines generate app specific RESTful web services for every app that is deployed to these engines.  These web services are useful for integrating into app/client specific third party/in-house systems.

• Store-and-forward – in order to support out-of-coverage (areas where there is no GSM coverage) operation, a message queue is used to keep cached data on the phone. Reports are stored on the handsets and transferred immediately or as soon as GSM network coverage is available. *This does not pertain to redemption of vouchers, which must take place on-line.

• Intelligent workflow – in-application administrative and decision support functions support the user on a real-time basis. Workflow automation, scheduling of tasks and triggering of notification services are orchestrated based on a predefined rule sets and algorithms.

• Speed, scalability and convenience of reporting – program flow guides the user through the application which makes data entry quick and effective. Forms can be submitted in an easy and intuitive process (more than ten million entry nodes have been collected by NQL 1-4 users across several use cases).

• Automatic data quality and integrity control – application will perform data field validation and monitor whether all the compulsory data fields were populated. Out-of-bound (unrealistic) entries will be queried.

• Remote deployment of new/updated workflow and report templates – as the programme and reporting requirements change over time, the enterprise client can remotely deploy a new program flow to all users at once.

• Location based services (native application specific) – provided that the phone model used in any deployment supports GPS readings, the application has the ability to upload the location of a transaction with the transaction report. The preferred resolution (accuracy) of the spatial recording can be pre-programmed to optimise battery usage (the higher the required resolution the more battery power is consumed to get a good location reading from the GPS satellites).

• Data encryption and SSL communication – a binary protocol with transport layer security (TLS) is used for communication between handsets and the application server. A server-side security service decodes and decrypts the binary protocol which provides a secure and compliant (SOAP and Java ESB) interface to the handset layer. Handsets authenticate themselves with a Unique User Identity number and password, which is stored on the server side.

• Interoperability of systems and data – Mezzanine’s Helium platform supports efficient bi-directional API integrations, enabling seamless workflow management and aggregation of system information.

• Financial Services Aggregator - This enables clients to link their programmes into relevant financial services, or vouchering programmes, enabling transactions between financial institutions and enterprises.

• Free rating of data traffic – data communication between the application server and the field worker application will be zero rated for transacting and can transact with a zero data balance.

• Network aggregation, and network agnostic - All Mezzanine products are network agnostic and have the ability to aggregate services across networks.

Through the shared service multi-tenancy approach Mezzanine is able to offer an end-to-end service level:

• 99% up-time

• All transactions replicated to a secondary instance.

• One secondary instance operating as a warm standby site.

• Point-in-time recovery for all source code and application data.

• All transactions constantly replicated to an off-site backup copy.

• Full backups performed on a weekly basis.

• Firewall protection for servers against threats from the Internet.

Commitment to delivering on the following performance targets: 

Mezzanine Ware (Pty) Ltd holds an ISO 27001:2013 certification, which is a globally trusted standard for Information Security. This certification was issued by BSI (British Standards Institute). Having an ISO 27001 certification demonstrates that the company has information security policies and controls that meet the requirements and guidelines of the standard. The certification is reviewed annually with an external surveillance audit. The certification covers the entire company and ensures that all staff members have been trained in Information Security and Risk Management, and that it is effectively applied through an Information Security Management System (ISMS).

• Country specific Ministry of Health (or nominated party) is the owner and Responsible Party of Information and data processed by the mVacciNation Application. Vodacom and Mezzanine has stringent technical and best practice procedures in place to ensure the integrity of Personal Information is safeguarded against the risk of loss or damage and against the unauthorised or unlawful access.

• All our systems are Protection of Personal Information (POPI) compliant and allow for capturing of user and client consent in the case of capturing personal information.

• Security is based on at least 99% Availability Service Levels and ISO 27001:2013 framework, which is the international standard that describes best practices and controls for an ISMS. 

• All products are built with open architecture for interoperability and alignment with local standards.

The following rules govern the gathering and use of client data:

• Administrative tasks are exclusively performed over SSH tunnels

• Database replication between PostgreSQL servers are exclusively performed over SSH tunnels

• Web applications can only be accessed over HTTPS

• Mobile applications can only access back-end services over HTTPS

• SSH tunnels use protocol version 2 with at least 1024-bit AES encryption

• Web and mobile applications use SSL RSA 2048 bits / SHA256 with RSA

• General application data is not encrypted on disk.

• Password stores for services such as MPesa are 128-bit AES encrypted

• Access to and modification of specific data through Helium web and mobile apps, SMS and e-mail are strictly enforced by the platform implementation of business rules provided by the client. This is further enforced by an extensive user acceptance testing process.

• Access to databases schemas with client data is limited to the Helium DevOps team, application developers and support staff.

• Employees are required to formally agree to no sharing, leaking or discussion of client data with outside parties except if it is in a written request/order from the client and has been approved by the relevant protocols.

All the (currently authorised and approved) vaccines against SARS-CoV-2 are required to be stored within specific temperature bands and if there is transgression outside of these bands there is a risk of physical corruption: this has negative clinical outcomes. In addition, cost management is a critical requirement: these vaccines are expensive and - in fragile, weakened supply chains and challenging operational conditions, the risk of waste is high.

It is therefore desirable to be able to monitor the vaccine cold chain. However, the locus of control may be vested more proximally, i.e., at the level of the Vaccine Manufacturer or Logistics Partner (often at the behest of the purchaser, e.g., Covax, Government, Insurer etc) of which there are many. As noted, there are at least 12 vaccines available in the market. Mezzanine can support a cold chain monitoring capability whereby mVacciNation users at VSP’s can capture fridge or container temperature and enter the data into the application. Mezzanine will not directly provide an IoT based cold chain sensor, but subject to a formal request from a client with an existing IoT solution in place (or envisaged), could integrate with such a solution through API; the data can then be displayed on the mVacciNation application.